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BACKGROUND: At present, the surgical methods for ankle osteoarthritis include joint replacement and joint fusion, but both methods have certain problems. Therefore, ankle preservation therapy has become the first choice for the initial treatment of ankle osteoarthritis. Ankle distraction arthroplasty is an important ankle-preserving procedure, which is beneficial to relieve ankle pain and improve function, and contribute to the self-repair of articular cartilage, but there is still a lack of definite biomechanical evidence. OBJECTIVE: To explore the mechanical factors of ankle osteoarthritis without obvious force line change in the early and middle periods using ankle distraction arthroplasty through the finite element modeling to provide mechanical evidence for clinical treatment. METHODS: The DICOM file of CT scan data of the foot and ankle of a 27-year-old volunteer was imported into the finite element software for three-dimensional reconstruction and curved surface fitting. The mesh was divided to establish a fine foot and ankle finite element model with bones, ligaments, tendons and cartilage. The biomechanical responses of tibiotalar joint surface stress, talus stress, and talus strain under three different working conditions of 0° neutral, 20° plantar flexion, and 20° dorsiflexion were compared between the ankle osteoarthritis and external fixator groups. RESULTS AND CONCLUSION: (1) Through the finite element simulation calculation, it was found that the overall stress of the ankle joint was smallest in the two groups of models when the neutral position was 0°. When the neutral position was gradually flexion or dorsiflexion, the stress value gradually increased with the change of ankle joint activity. Under the same flexion condition, the overall stress of dorsiflexion was significantly greater than that of the plantar flexion. (2) In terms of the peak stress of the tibiotalar ankle joint, the peak value of the stress of the talar joint surface in the ankle osteoarthritis group increased significantly than that in the normal group, and the peak value of the stress of the tibiotalar joint surface in the external fixator group decreased significantly. (3) For the overall deformation of the ankle joint, the overall deformation of the ankle osteoarthritis group increased the most in the neutral position, while the overall deformation of the external fixator group decreased the most. (4) For the talar stress, the stress of the talus in the ankle osteoarthritis group increased in different degrees under three working conditions. The stress of the talus in the external fixator group decreased, especially in the neutral position. (5) In terms of the forward distance of the talus, the forward distance of the talus in the ankle osteoarthritis group decreased significantly compared with that in the normal group, while the forward distance of the talus in the external fixator group did not increase significantly. (6) It is concluded that through the finite element simulation analysis of two groups of ankle models under different working conditions, it is confirmed that the clinical application of ankle distraction arthroplasty can alter the mechanical stress of tibiotalar joint surface and talus in patients with ankle osteoarthritis, improve the mechanical distribution of the local joints, and delay the development of ankle osteoarthritis. [ABSTRACT FROM AUTHOR]

BACKGROUND: The traditional Ilizarov bone transfer technique is used to treat large segmental bone defects of long bones. Although the curative effect is good, due to factors such as the length of wearing external fixation, bone bending deformity, retraction of the extension zone, and refracture, it affects the clinical effect of bone transfer. Biplanar osteotomy and bone transport combined with intramedullary nailing has many advantages. OBJECTIVE: To analyze the effect of biplanar osteotomy and bone transport combined with intramedullary nailing in the treatment of large segmental tibial bone defects. METHODS: A retrospective analysis was performed on eight patients with large segmental tibial bone defects who were admitted from July 2016 to June 2020, including seven males and one female, with an average age of 39.3 years (33-50 years old). Causes of injury: five cases were injured by traffic accident and three cases were injured by heavy objects. After debridement, the skin defect ranged from 6.5 cm×1.3 cm to 23.1 cm×9.7 cm, with an average of 10.01 cm× 5.51 cm. The length of the tibial defect was 6.8-12.1 cm (averagely 9.2 cm). All patients were treated with biplanar osteotomy and bone transport combined with intramedullary nailing for the treatment of large segmental tibial bone defects. In two patients, the bone defect was located in the middle of the tibia. After biplanar osteotomy was performed at the proximal and distal ends of the tibia, intramedullary nails were placed and fixed with locking nails at the distal and proximal ends. The bone fragments at both ends were transported to the middle. In six patients, the bone defect was located at the distal end of the tibia, and a biplanar osteotomy was performed at the proximal end of the tibia. An intramedullary nail was placed and fixed with locking nails at the distal and proximal ends. The proximal two bone fragments were transported anterogradely. The bone migration time, the mineralization time of the traction zone, the healing index, the external fixation time, the external fixation index and the complications of the patients were recorded. Bone healing and limb function were evaluated using the Association for the Study and Application of the Methods of Ilizarov score. RESULTS AND CONCLUSION: (1) All eight patients were followed up after operation, and the follow-up time ranged from 19 to 33 months. All patients achieved bone union, and no infection or recurrence occurred during treatment. (2) Bone migration time was 36-62 days, with an average of 50.2 days. Solidification time in the traction area was 267-512 days, with an average of 366.9 days. Healing index was 1.18-1.41 months/cm, with an average of 1.31 months/cm. External fixation time was 5.5-12.5 months, with an average of 8.3 months. External fixation index was 0.73-0.99 months/cm, with an average of 0.86 months/ cm. (3) There were three patients with nonunion of the butt joint. (4) According to the Association for the Study and Application of the Methods of Ilizarov score, five patients (62%) were excellent, and three patients (38%) were poor. Functional results were excellent in six cases (75%) and good in two cases (25%). (5) It is concluded that biplanar osteotomy and bone transport combined with intramedullary nailing can significantly shorten the external fixation time, reduce the probability of complications such as needle tract infection, poor alignment, and refracture in the extension area. This is an effective method for the treatment of large segmental tibial bone defects [ABSTRACT FROM AUTHOR]

Objective: To observe the therapeutic effect of transverse tibial bone transfer combined with vacuum sealing drainage (VSD) in the treatment of diabetic foot ulcers (DFU). Methods: 65 patients with DFU who were treated in our hospital from April 2018 to July 2020 were selected. According to the different treatment methods, the patients were divided into group A (32 cases, VSD treatment) and group B (33 cases, transverse tibial bone transfer combined with VSD treatment) . The perioperative indexes, affected foot skin temperature, visual pain simulation (VAS) score, ankle brachial index (ABI) and serum related indexes changes were compared between the two groups, and the incidence of complications in two groups was recorded. Results: Two groups at 1 month after operation, the affected foot skin temperature and ABI increased, and the VAS score decreased, and the change range in group B was significantly greater than that in group A (P<0.05). There were no differences in complete weight-bearing time and walking time on the ground between the two groups (P>0.05). The ulcer healing time and removal time of external fixator in group B were significantly shorter than those in group A (P<0.05). Two groups at 1 month after operation, vascular endothelial growth factor (VEGF) increased, white blood cell count (WBC) and C-reactive protein (CRP) levels decreased, and the change range in group B was significantly greater than that in group A (P<0.05).There was no significant difference in the incidence of complications between the two groups (P>0.05). Conclusion: Transverse tibial bone transfer combined with VSD in the treatment of DFU can promote wound healing, with remarkable effect. [ABSTRACT FROM AUTHOR]

Objective: To investigate the clinical effect of limited open reduction treatment of proximal phalangeal fracture with miniature external fixator combined with small incision., Methods: Between January 2020 and December 2022, 29 patients with proximal phalangeal fracture were treated with micro external fixator combined with small incision in fracture plane, including 23 males and 6 females, aged from 19 to 62 years old with an average of (36.2±21.0) years old. Five patients with open phalangeal fracture were treated with stageⅠsurgery, 24 cases of closed phalangeal fracture were treated with elective surgery. At the 6 month follow-up, the curative effect was evaluated according to the total active flexion scale (TAFS) of the American Hand Surgery Association. The fracture healing, nail path, local soft tissue healing, and complications were observed., Results: All the 29 patients were followed up for 6 to 10 months with an average of(8.3±2.1) months, 3 patients had delayed fracture healing, 1 patient had distal skin numbness, symptoms were relieved after nutritional nerve treatment, no external fixator broken nails, no infection, the nail path and small incision healing was good, bone healing was achieved at the end of follow-up. Fracture healing time ranged from 10 to 24 with an average of (13.7±3.1) weeks. Six months after operation, according to the TAFS standard, 19 cases (227.68±4.23) were excellent, 7 cases (203.86±14.32) were good, and 3 cases (170.33±7.32) were poor., Conclusion: The micro-combined external fixator combined with limited incision with small incision can be used in the treatment of proximal phalangeal fracture. The operation is simple and beneficial to early functional exercise, small extensor tendon irritation, convenient second-stage removal, and high rate of excellent and good functional score in recovery period.

BACKGROUND: In order to solve the complications of external fixation screws, various modified screws have emerged, but there is a lack of suitable animal models and evaluation methods for validating their efficacy, especially for simulating real loads. OBJECTIVE: To construct a simple, rational and efficient model that can be used to validate the efficacy of external fixator screws in Sprague-Dawley rats and establish the corresponding evaluation methods. METHODS: Thirty male adult Sprague-Dawley rats underwent the right femoral osteotomy, followed by fixation with a homemade external fixator system. Routine X-ray films were taken on the day after operation and 1, 2, 4, and 6 weeks after operation. During this period, the activity of rats was observed. At 6 weeks after operation, the rats were euthanized, and the right thigh femur with screw specimens were taken for general observation, biomechanical measurement, micro-CT, three-dimensional reconstruction analysis of the screw path and histological observation. RESULTS AND CONCLUSION: The modeling time of external fixation model of rat femoral fracture was (20±5) minutes. The general condition and activity of rats were good during the experiment. In general, 28 (93%) of the 30 femoral specimens with screws achieved bone healing; 1 case (3%) had poor pseudoarthrosis formation with severe screw loosening accompanied by large osteolysis around the proximal screw path; 1 case (3%) had mild screw loosening combined with severe screw path infection; 1 case (3%) only had severe screw path infection. The overall satisfactory rate of the model was 90% (27/30). Radiological findings revealed that the right femoral screws were fixed in place without loosening, the bone morphology was restored, the broken end was well aligned, no free body was seen around the broken end, and the right hip and knee were in position at 6 weeks after operation. Micro-CT three-dimensional analysis showed that body mineral density, bone volume fraction, and the number of bone trabeculae around the internal screw path were (0.426 7±0.088 7) mg/cm2, (3.125 2±1.004 2)%, and (0.000 3±0.000 1) /μm respectively, at 6 weeks after operation. Intra-model group distribution and normality test were performed, and all the data tended to be stable and normally distributed. Hematoxylin-eosin staining showed that the area around the screw path was repaired by a large amount of proliferating granulation tissue, and new bone tissue was visible at the edges. Von Kossa staining revealed the presence of extensive black or brownish-black calcium deposition around the screw path. Biomechanically, the screw extraction force was (130.416 7±35.008 0) N, which tended to be generally stable and normally distributed (P=0.245 6). To conclude, the validation model and evaluation method for the efficacy of external femoral fixator screws in Sprague-Dawley rats can be evaluated from three aspects: histology, imaging and biomechanics, and the screw path can be comprehensively evaluated. The design is scientific and reasonable, the procedure is simple, and the success rate is high. Therefore, this validation model has good value for scientific research and clinical application. [ABSTRACT FROM AUTHOR]

BACKGROUND: Bone transfer is an effective treatment of bone defect caused by various causes. However, the complications, such as long wearing time of the external fixator, the loss of extended bone length, and bending deformities, restrict its application. OBJECTIVE: To explore the difference in the efficacy of single-level osteotomy combined with intramedullary nail and single-level osteotomy in the treatment of tibial bone defect. METHODS: Patients with tibial bone defect were selected from Tangshan Second Hospital from January 2011 to April 2018. Fifteen patients treated with singlelevel osteotomy and bone transfer combined with intramedullary nail were used as the trial group. Thirty patients treated with single-level osteotomy and bone transfer were used as the control group. After treatment, follow-up was carried out by the combination of outpatient follow-up, phone call and Wechat video. The mineralization time of regeneration area, healing index, external fixation time, external fixation index, joint healing, needle infection, and refracture were compared between the two groups. The scoring standard of Association of Study and Application on Method of Ilizarov was used to evaluate the bone healing and function. RESULTS AND CONCLUSION: (1) The patients in both groups were followed up for (31.0±7.3) months. The incision had no redness, swelling, or pain, and needle tract infection were controlled after removal of the outer frame. (2) There was no significant difference in mineralization time, healing index, refracture rate, and joint healing between the two groups (P > 0.05). The external fixation index was smaller in the trial group than that in the control group (P < 0.05). Number of patients with bone end cleaning and bone grafting was smaller in the trial group than that in the control group (P < 0.05). The rate of needle tract infection was lower in the trial group than that in the control group (P < 0.05). (3) ASAMI score was better in the trial group than that in the control group (P < 0.05). (4) It is concluded that compared with the single-level osteotomy and bone transfer, single-level osteotomy and bone transfer combined with intramedullary nail in the treatment of tibial bone defect can shorten the fixator time, reduce the probability of postoperative debridement and replantation of bone compression, and avoid needle tract infection. [ABSTRACT FROM AUTHOR]

OBJECTIVE: Tibial plateau fractures are more prone to postoperative complications and adverse reactions. At present, the most commonly used surgical methods for the treatment of tibial plateau fractures are open reduction with internal fixation and circular external fixators. There are few comparative studies on the prognosis of the two surgical methods. There are many controversies about the choice of surgical method. This article evaluates the clinical efficacy of open reduction internal fixation and circular external fixation for tibial plateau fractures through meta-analysis. METHODS: From 2005 to 2020, PubMed, EMbase, Cochrane Library, Wanfang, CNKI, and VIP databases related to open reduction and internal fixation and circular external fixation in the treatment of tibial plateau fractures were searched by computer for clinical randomized controlled trials and retrospective cohort studies. After reading and screening the literature, in turn, the retrospective cohort studies that met the screening requirements were evaluated using the Newcastle-Ottawa Scale. The risk of bias in the randomized controlled trials was evaluated using the Cochrane Handbook standard. RevMan 5.3 software was used to conduct meta-analysis of the data. RESULTS: (1) A total of 11 articles were included. Among them, 374 patients used open reduction and internal fixation; 316 patients used circular external fixation. Two randomized controlled case trials mentioned random methods. Nine retrospective cohort studies evaluated the literature quality according to the NewcastleOttawa Scale, including 3 articles with 8 points, 5 articles with 7 points, 1 article with 6 points; the quality of the literature was good, and the data had good authenticity and reliability. (2) The results of meta-analysis showed that the range of motion (MD=-4.83, 95%CI:-7.01 to -2.65, P < 0.000 1) and postoperative infection rate (OR=0.22, 95%CI:0.13-0.40, P < 0.000 01) in the open reduction and internal fixation group were better than those in the circular external fixation group. The length of hospital stay in the circular external fixation group was better than that in the open reduction and internal fixation group (MD=8.01, 95%CI:7.05-8.96, P < 0.000 01). (3) There was no significant difference in poor postoperative healing, postoperative osteoarthritis, postoperative knee varus, and RSS score between open reduction and internal fixation group and circular external fixation group (P > 0.05). CONCLUSION: In the treatment of tibial plateau fractures, compared with the circular external fixation, the open reduction and internal fixation has a lower risk of postoperative infection and better postoperative range of motion, but patients repaired by the circular external fixation have a shorter hospital stay. [ABSTRACT FROM AUTHOR]

BACKGROUND: The number of patients with osteomyelitis, bone defects, and lower extremity deformities due to open fractures of the lower limb has increased significantly, leading to an increasing use of Ilizarov circular external fixators. Although the Ilizarov circular external fixator has achieved good results in the treatment of these conditions, there are still many defects. OBJECTIVE: To summarize the progress of the development and application of hexapod external fixator in the treatment of lower limb deformity. METHODS: Articles from PubMed, CNKI and Wanfang database from February 2001 to February 2021 were retrieved with the key words of “hexapod external frame, taylor spatial frame, ortho-SUV, truelok-Hex” in both English and Chinese. Fifty articles were included, and the application progress of the hexapod external fixator in the treatment of lower limb deformity was reviewed. RESULTS AND CONCLUSION: (1) The application of circular external fixator in the treatment of extremities fracture and limb deformity that are not suitable for internal fixation has achieved positive results, and can be used to pull bone and regenerate soft tissue following the tension-stress rule, curing various diseases that cannot be treated by traditional orthopedic technology. (2) The Ilizarov circular fixator suffers from defects such as long treatment cycle, complex operation and high requirement on physician experience. (3) The main feature of the hexapod external fixator is that it forms a virtual hinge through six adjustable telescopic struts to realize multi-plane deformities and correct simultaneously, and there is no need to replace the hinge during the treatment. With the help of computer software, the accuracy of correction is improved significantly, and the residual rate of malformation is reduced significantly. (4) The hexapod external fixator has been widely used in the treatment of lower limb non-union, bone defect, clubfoot, joint deformity and other diseases, and can significantly reduce the incidence of postoperative complications compared with the Ilizarov circular external fixator. (5) The shortcomings of the hexapod external fixator, such as poor stability, misuses, difficult learning process and high price, make it unable to be further popularized. (6) In the future, it is necessary to improve the prescription software, reduce the influence of human factors, gradually realize intellectualize and informationize hexapod external fixator. Also, it is critical to achieve independent research and development and reduce the cost of use so as to make hexapod external fixator being widely used. [ABSTRACT FROM AUTHOR]

Objective: To explore the effectiveness of reduction robot combined with navigation robot-assisted minimally invasive treatment for Tile type B pelvic fractures., Methods: Between January 2022 and February 2023, 10 patients with Tile type B pelvic fractures were admitted. There were 6 males and 4 females with an average age of 45.5 years (range, 30-71 years). The fractures were caused by traffic accident in 5 cases, bruising by heavy object in 3 cases, and falling from height in 2 cases. The interval between injury and operation ranged from 4-13 days (mean, 6.8 days). There were 2 cases of Tile type B1 fractures, 1 case of Tile type B2 fracture, and 7 cases of Tile type B3 fractures. After closed reduction under assistance of reduction robot, the anterior ring was fixed with percutaneous screws with or without internal fixator, and the posterior ring was fixed with sacroiliac joint screws under assistance of navigation robot. The time of fracture reduction assisted by the reduction robot was recorded and the quality of fracture reduction was evaluated according to the Matta scoring criteria. The operation time, intraoperative fluoroscopy frequency and time, intraoperative bleeding volume, and incidence of complications were also recorded. During follow-up, the X-ray film of pelvis was taken to review the fracture healing, and the Majeed score was used to evaluate hip joint function., Results: The time of fracture reduction was 42-62 minutes (mean, 52.3 minutes). The quality of fracture reduction according to the Matta scoring criteria was rated as excellent in 4 cases, good in 5 cases, and poor in 1 case, with excellent and good rate of 90%. The operation time was 180-235 minutes (mean, 215.5 minutes). Intraoperative fluoroscopy was performed 18-66 times (mean, 31.8 times). Intraoperative fluoroscopy time was 16-59 seconds (mean, 28.6 seconds). The intraoperative bleeding volume was 50-200 mL (range, 110.0 mL). No significant vascular or nerve injury occurred during operation. All patients were followed up 13-18 months (mean, 16 months). X-ray films showed that all fractures healed with the healing time of 11-14 weeks (mean, 12.3 weeks). One case of ectopic ossification occurred during follow-up. At last follow-up, the Majeed score was 70-92 (mean, 72.7), and the hip joint function was rated as excellent in 2 cases and good in 8 cases, with the excellent and good rate of 100%., Conclusion: The reduction robot combined with navigation robot-assisted minimally invasive treatment for Tile type B pelvic fractures has the characteristics of intelligence, high safety, convenient operation, and minimally invasive treatment, which can achieve reliable effectiveness.

Objective: To analyze the effectiveness of external fixator combined with Kirschner wire (EF-KW) fixation in the treatment of oblique and comminuted distal humeral metaphyseal-diaphyseal junction (DHMDJ) fractures in children., Methods: A clinical data of 22 children with DHMDJ fractures who met the selection criteria between April 2021 and December 2023 was retrospectively analyzed. All patients were treated with EF-KW fixation. There were 14 boys and 8 girls with an average age of 6.8 years (range, 1.5-12.0 years). The time from injury to operation was 14-38 hours (mean, 24.2 hours). There were 18 cases of comminuted fractures and 4 cases of oblique fractures; and 1 case of median nerve injury and 1 case of radial nerve injury before operation. The occurrence of postoperative complications was recorded. At last follow-up, the function of the affected elbow joint was evaluated according to the Mayo elbow joint function score, and the Baumann's angle (BA) and humero-capitellar angle (HCA) of the affected and healthy sides were recorded and compared., Results: All fractures were successfully treated with closed reduction and no complications such as nerve injury occurred. Superficial infection occurred in 4 cases after operation and healed after symptomatic treatment. The incisions of other patients healed by first intention. All patients were followed up 9-24 months (mean, 13.8 months). At last follow-up, according to the Mayo elbow joint function score, the elbow joint function was rated as excellent in 15 cases, good in 6 cases, and fair in 1 case, with an excellent and good rate of 95.5%. The neurologic injury before operation recovered gradually. X-ray films reexamination showed that all fractures healed, and the healing time of fractures ranged from 29 to 61 days, with an average of 35.6 days. At last follow-up, there was no significant difference in BA and HCA between the healthy side and the affected side ( P >0.05). During follow-up, 1 case developed mild cubitus varus, while the other patients had no serious complications., Conclusion: EF-KW fixation for oblique and comminuted DHMDJ fractures in children has the advantages of less trauma, simple operation, easy reduction, good stability after reduction, low incidence of serious complications, and good elbow functional recovery.

BACKGROUND: Type C distal radius fractures are often treated with external fixation. However, some patients still have undesirable symptoms such as delayed fracture healing and slow growth of callus. How to promote fracture healing and recovery of wrist joint function after surgery is of great significance. OBJECTIVE: To investigate the effect of mid-frequency pulse therapy combined with external fixator on type C distal radius fracture and its influence on oxidative stress and inflammatory mediators. METHODS: Clinical data of 86 patients with type C distal radius fracture admitted in Guangdong Provincial People’s Hospital from January to December 2018 were analyzed retrospectively. Patients were divided into two groups according to different treatment methods: external fixation group (n=41 cases) and combined group (mid-frequency pulse therapy combined with external fixation treatment, n=45 cases). The clinical effect of different treatment methods was observed, and the changes of serum inflammatory mediators and oxidative stress indexes before and 4 weeks after treatment were compared between the two groups. RESULTS AND CONCLUSION: (1) The quantitative score of callus in the combined group was higher than that in the external fixation group, and the visual analogue scale score and Gartland-Werley score were lower than that in the external fixation group (P < 0.05). (2) At 4 weeks after treatment, malondialdehyde and advanced oxidation protein product levels decreased, and the level in the combined group was lower than that in the external fixation group (P < 0.05). The level of antioxidant glutathione peroxidase and superoxide dismutase levels increased; the level in the combined group was higher than that in the external fixation group (P < 0.05). (3) At 4 weeks after treatment, the levels of C-reactive protein, interleukin-6, and interleukin-1 β in the serum of the two groups were significantly lower than those before treatment (P < 0.05), and the levels in the combined group were lower than those in the external fixation group (P < 0.05). (4) It is concluded that mid-frequency pulse therapy combined with external fixator can promote the healing of type C distal radius fracture and the functional recovery of wrist joint, reduce postoperative inflammation and oxidative stress. [ABSTRACT FROM AUTHOR]

BACKGROUND: Olecranon fracture-dislocations are complicated fractures and dislocations of the elbow, which adds certain challenges to clinical diagnosis and treatment. Although the continuous improvement of medical standards has made some progress in the clinical diagnosis and treatment of olecranon fracture-dislocations, some controversial issues need to further discuss. OBJECTIVE: To consult and sort out the relevant literature about the clinical diagnosis and treatment of olecranon fracture-dislocations, and give a summary. METHODS: The first author searched the relevant documents collected by Web of Science, PubMed and CNKI databases from 2000 to 2020. The key words were “olecranon; elbow; fracture dislocation; 3D printing” in English and Chinese. The massive relevant literature was reviewed and collected. The literature was classified and analyzed from the aspects of anatomical mechanics, injury characteristics, diagnostic typing and surgical treatment. RESULTS AND CONCLUSION: (1) The anatomy of the olecranon, coronoid process, radial head, and the anatomical mechanical characteristics between the soft tissues affect the clinical diagnosis and treatment of olecranon fracture-dislocations. (2) Both anterior and posterior dislocations have their own injury characteristics and are easily confused with Monteggia fractures. Accurate grasp of physical examination and auxiliary imaging examination is conducive to clinical diagnosis. (3) The posterior midline approach is more commonly used, and other approaches should be combined if necessary. Proper fixation and repair of bone and soft tissue, as well as timely auxiliary external fixator, are conducive to improving the clinical efficacy of olecranon fracture-dislocations. (4) However, the damage mechanism of the rear olecranon fracture-dislocations needs to be further explored, and whether to establish independent classification of olecranon fracture-dislocations needs further discussion. The effectiveness of the indirect fixation of the coronoid process behind the olecranon still needs further research. (5) In addition, the emerging three-dimensional printing technology is of great significance for preoperative planning and simulation of bone trauma, and will be more conducive to the development of clinical diagnosis and treatment of olecranon fracture-dislocations. [ABSTRACT FROM AUTHOR]

Objective: To design and test a device which is capable of accurately measuring and dynamically adjusting the axial pressure at the fracture end in real-time., Methods: Upon completion of the design, the pressure measurement and adjustment device was implemented in a canine tibial fracture external fixation model. A pressure sensor was mounted at the fracture end, and the displayed values of the pressure sensor were used as the standard for comparison. The relationship between the displayed values of the measurement and adjustment device and the pressure sensor under identical conditions was examined., Results: The device was utilized in external fixation models of tibial fractures in five beagles. A linear correlation was observed between the displayed values of the device and the pressure sensor at the fracture end. The measurement values from the device could be transformed into fracture end pressure through the application of coefficients, thereby facilitating accurate measurement and dynamic adjustment of the fracture end pressure., Conclusion: The pressure measurement and adjustment device at the fracture end is easy to operate, enabling precise measurement and dynamic regulation of the pressure at the fracture end. It is well-suited for animal experiments aimed at investigating the impact of axial compression on fracture healing, demonstrating promising potential for experimental applications.

Objective: To summarize the research progress in the treatment of distal humeral metaphyseal-diaphyseal junction (DHMDJ) fractures in children and to provide reference for clinical practice., Methods: The characteristics and treatment methods of transverse and comminuted DHMDJ fractures in children were summarized and analyzed by referring to relevant literature at home and abroad., Results: DHMDJ fractures in children are not uncommon clinically, with high fracture line position, multi-directional instability, difficult closed reduction in treatment, and easy to cause complications such as coronal and sagittal deformity of the elbow. The Kirschner wire technique was effective for DHMDJ fractures with the fracture line at the middle and low levels, but was prone to iatrogenic ulnar nerve injury. Elastic stable intramedullary nail is suitable for higher-position transverse DHMDJ fractures. However, this technique requires a second operation to remove the internal fixator, and may cause iatrogenic epiphysis plate injury in children. External fixator is a new way to treat DHMDJ fractures, and it can show satisfactory results for transverse and comminuted DHMDJ fractures. However, at present, there are few relevant studies, and most of them focus on biomechanical studies, and the efficacy lacks high-quality clinical research support., Conclusion: The ultimate goal of DHMDJ fracture treatment in children is to restore the anatomical alignment of the fracture and prevent the loss of reduction. The choice of internal fixator depends on the location of the fracture line and the shape of the fracture to provide personalized treatment.

BACKGROUND: Establishment of a standard experimental animal model of atrophic nonunion is necessary for experimental study and related treatment of atrophic nonunion. However, the common modeling methods cannot accurately simulate atrophic nonunion in the clinical practice. OBJECTIVE: To construct a standard animal model of atrophic nonunion. METHODS: Thirty male Sprague-Dawley rats were randomly divided into experimental and control groups. All animals were subjected to bone cutting at the middle-lower segment of the right tibia and the circular external fixator was applied to keep a 4 mm defect interval. The animals in the experimental group were subjected to an additional cauterization of the periosteum at the fracture end of the tibia with a length of 1mm. The periosteum was not treated in the control group. The study protocol was approved by the Experimental Animal Ethics Committee of the First Affiliated Hospital of Guangzhou University of Chinese Medicine on January 01, 2018, with approval No. TCMF1-2018002. RESULTS AND CONCLUSION: After modeling, there was one case of loose external fixation in each group, and no infection occurred in both groups. Imaging examination showed no bone connection and no sign of healing between the fractures of the tibia in the two groups at 6 weeks after modeling. Imaging and histological findings showed no healing at the end of fracture but typical atrophic nonunion in the experimental group at 12 weeks after modeling. By contrast, six animals had atrophic nonunion, and eight had hypertrophic nonunion in the control group. Overall, the animal model of atrophic tibial nonunion can be successfully constructed using circular external fixator combined with periosteal cauterization at the fracture end. [ABSTRACT FROM AUTHOR]

BACKGROUND: The study on the mechanism of force conduction of llizarov bone external fixator is of great significance for clinical orthodontics of the knee varus, the knee valgus and the tibial fracture. OBJECTIVE: To explore the force conduction mechanism of llizarov bone external fixator and the force changes of each orthopedic force in the process of tibia correction, and to objectively evaluate the overall use effect of the external fixator. METHODS: According to the structure of the external fixator, the coordinate transformation matrix relations were established, and the mathematical transformation relationship between the holding force and the pulling tension was obtained. A special laboratory bench was set. The experiment of tibia correction was conducted. The load on the external fixator and the variation of the orthotic force were measured. The theoretical value of the tension at the broken bone is calculated and compared with the actual value of the tension measured by the six-dimensional force sensor. The curve of efficiency of force transmission during correction was obtained. RESULTS AND CONCLUSION: (1) During the correction, the structure of the llizarov bone external fixator resulted in the interaction and restriction of its adjustment rod and support rod. When one adjustment force increased, the other adjustment force would decrease. (2) The efficiency of force transmission was increased greatly in the early stage, and then stabilized at about 50%. The experimental results could evaluate the overall correction effect of the external fixator. (3) Theoretical calculation and experiment of the tension at the broken bone due to the loss during the force transmission process were different in the result curves, but from the experimental results, it could be indicated that the overall force change trend of the adjustment force, supporting force, the theoretical value of the tension and the actual value of the tension was basically the same, indicating the validity of the theoretical calculations and experimental results. The evaluation results can provide a reference for the optimal design of llizarov's external fixation architecture and the precise control of tibial orthopedic surgery. [ABSTRACT FROM AUTHOR]

BACKGROUND: Membrane induction technique for treating long bone defects has advantages of few complications, significant treatment efficacy and ease in operation. In previous studies, membrane induction technique was used to treat bone defect patients with good cartilage tissue, but there are few reports regarding bone defects with large area of cartilage tissue defect or accompanying infection. OBJECTIVE: To analyze the efficacy of flap transplantation combined with membrane induction technique for repairing long bone defects and soft tissue defects. METHODS: Fifteen patients with long bone defects and soft tissue defects who were treated in Affiliated Nanhua Hospital, University of South China from October 2016 to August 2018 were selected. They were aged (47.15±8.16) years. The soft tissue defect area was 5.1 cm x 3.4 cm 21.8 cm x 9.4 cm. The length of bone defect was 5.8-19.5 cm, with an average of (11.4±2.3) cm. The patients with mildly polluted wounds underwent debridement, external fixation of fracture, and filling bone cement in the bone defect area. Wounds were covered with local pedicle flaps or free flaps. Wound infection patients underwent vacuum sealing drainage, bone cement filling and flap surgery after infection was controlled. The second graft surgery was performed at 8 to 12 weeks after primary intention, and patients were followed up for 12 months. This study was approved by the Institutional Ethics Committee of Affiliated Nanhua Hospital, University of South China. RESULTS AND CONCLUSION: (1) Nine patients with mildly contaminated wounds were treated with external fixation after debridement, bone cement filling and flap transposition. No infection occurred. (2) Six patients with infection were treated with vacuum sealing drainage for 1 to 2 weeks. After the infection was controlled completely, bone cement filling and flap transplantation were conducted. All wounds were healed. (3) Fifteen patients achieved bone healing after second bone grafting. The healing time was between 8 and 12 months, with an average of (9.18±2.10) months. (4) These results suggest that skin flap transplantation combined with membrane induction technique can effectively treat patients with long bone defects and soft tissue defects. [ABSTRACT FROM AUTHOR]

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Objective: To analyze the effectiveness comparison of external fixator combined with Kirschner wire fixation and Kirschner wire fixation in the treatment of cubitus varus deformity in children., Methods: A retrospective case-control study was conducted to collect 36 children of postoperative supracondylar humerus fracture complicating cubitus varus deformity between January 2018 and July 2022. Among them, 17 cases were treated with distal humeral wedge osteotomy external fixation combined with Kirschner wire fixation (observation group), and 19 cases were treated with distal humeral wedge osteotomy and Kirschner wire fixation (control group). The baseline data including age, gender, deformity side, time from fracture to operation, carrying angle of the healthy side and preoperative carrying angle of the affected side, elbow flexion and extension range of motion, and lateral condylar prominence index (LCPI) showed no significant difference between the two groups ( P >0.05). The operation time, hospitalization cost, healing time of osteotomy, postoperative complications, and the carrying angle, LCPI, and elbow flexion and extention range of motion were recorded and compared between the two groups. The elbow function was assessed by Oppenheim score at 3 months after operation and at last follow-up., Results: The children in both groups were followed up 13-48 months, with an average of 26.7 months. There was 1 case of needle tract infection in the observation group and 2 cases in the control group, and no nerve injury occurred, the difference in the incidence of complication (5.88% vs 10.53%) between the two groups was not significant ( χ 2 =0.502, P =0.593). There was no significant difference in the operation time and fracture healing time between the two groups ( P >0.05); the hospitalization cost of the observation group was significantly higher than that of the control group ( P <0.05). The Oppenheim score of the observation group was significantly better than that of the control group at 3 months after operation ( P <0.05), but there was no significant difference in the Oppenheim score between the two groups at last follow-up ( P >0.05). At last follow-up, the carrying angle of affected side significantly improved in both groups when compared with preoperative ones ( P <0.05); the differences of the pre- and post-operative carrying angle of affected side and elbow flexion and extension range of motion showed no significant differences between the two groups ( P >0.05), but the difference in pre- and post-operative LCPI of the observation group was significantly better than that of the control group ( P <0.05)., Conclusion: External fixator combined with Kirschner wire fixation and Kirschner wire fixation both can achieve satisfactory correction of cubitus varus deformity in children, and the former can achieve better short-term functional recovery of elbow joint and reduce the incidence of humeral lateral condyle protrusion.

BACKGROUND: Internal fixation with intramedullary nails is the most commonly used technique for closed femoral fractures, but external fixators are needed to stabilize open fractures in order to maintain rotational stability. Because the load acting on the fracture and the stability of the fixator determine the relative displacement of the broken end of the bone, the device may affect the physiological load of the operative limb, and then affect the healing. OBJECTIVE: To compare the effects of different stiffness external fixators on the formation and stability of fracture healing tissues in mice, in order to find a new way of effective fracture fixation treatment. METHODS: We introduced such a model using rigid and flexible external fixators with considerably different stiffness (axial stiffness of 17.9 and 0.76 N/mm, respectively). Both fixators were used to stabilize a 0.5 mm osteotomy gap in the femur of C57B/6 mice. Three-point bending tests, μCT, and histomorphometry demonstrated a different healing pattern after 21 days. RESULTS AND CONCLUSION: (1) Flexural stiffness of the rigid group was significantly reduced by 28.1% compared with the control intact bone, while flexural fixation reduced the flexural rigidity to 18.9% of the intact bone with no significant difference between the two groups after 21 days (P > 0.05). (2) Compared with the rigid group, the volume of the whole callus of the flexible group was more than doubled, and the maximum diameter also significantly increased (P < 0.05); while the bone volume fraction significantly decreased (P < 0.05). (3) Histological analysis showed that the numbers of braided bone, laminar bone and cartilage in the callus in the flexible group were significantly higher than those of the rigid group (P < 0.05). (4) The selected rigid and flexible fixations with different stiffness both lead to callus formation, but healing is delayed under flexible fixation. [ABSTRACT FROM AUTHOR]

BACKGROUND: “Accordion” technique achieves satisfactory outcomes in the treatment of nonunion, but there is a lack of basic research. OBJECTIVE: To verify that the “accordion” technique is effective for nonunion in New Zealand white rabbits. METHODS: The model of unilateral femoral fracture with noninfectious nonunion was created in the New Zealand white rabbits. The model rabbits were then divided into three groups: experimental group: treated with “accordion” technique (4 weeks of pressure with external fixator at a speed of 0.5 mm/d, then 2 weeks of retraction at the same speed, and finally 4 weeks of pressure); control group: external fixation and pressure; blank control group: only external fixation. The rabbits underwent X-ray examination at 2, 4, 6, 8 and 12 weeks. The fracture specimens were taken for hematoxylin-eosin staining and histological observation. RESULTS AND CONCLUSION: The X-ray examination of the experimental group suggested that the fracture was healed, while the control group and the blank control group still did not heal (P < 0.01). Histological examination showed that the fracture stump of the experimental group changed from the nonunion state to the healing state, and the blank control and control groups showed no obvious changes. Thus, “accordion” technology is a simple, minimally invasive and efficient treatment method for nonunion. [ABSTRACT FROM AUTHOR]

BACKGROUND: For fracture of distal radius in adults, choosing casting external or open reduction and internal fixation (ORIF) with plates remains controversial. OBJECTIVE: To analyze the results of closed reduction and casting versus ORIF with plates in treatment of fracture of distal radius in adults. METHODS: Databases of PubMed, EMbase, The Cochrane Library (Issue 11, 2017), OVID, Web of Science, CNKI and WanFang were searched. The randomized controlled trials about casting and plate for the fracture of distal radius published before March 2018 were collected. The literature screening was conducted by two researchers independently based on the incision and exclusion criteria, followed by data extraction and bias evaluation. Meta-analysis was performed on RevManager 5.3 software. RESULTS AND CONCLUSION: (1) Fifteen randomized controlled trials were included involving 1 545 patients. (2) Meta-analysis results showed that there were no significant differences in the Disabilities of the Arm, Shoulder and Hand scores (MD=1.83, 95%CI (-0.06, 3.72), P=0.06), Patient-Rated Wrist Evaluation Questionnaire scores (MD=4.01, 95%CI (-4.96, 12.99), P=0.38), range of motion of the wrist joint in dorsiflexion and ulnar deviation (MD=-7.47, 95%CI (-15.40, 0.47), P=0.07; MD=-5.45, 95%CI (-13.82, 2.93), P=0.20) between two groups. The plate groups had a higher Gartland and Werley category (OR=0.52, 95%CI (0.30, 0.90), P=0.02) and grip strength (MD=-10.01, 95%CI (-17.04，-2.99), P=0.005). (3) In the plate group, the incidence of tendinitis (RR=0.10, 95%CI (0.02, 0.51), P=0.006), carpal tunnel syndrome (RR=3.20, 95%CI (1.14, 8.96), P=0.03) and finger stiffness (RR=9.29, 95%CI (1.80, 47.79), P=0.008) were significantly increased. (4) To conclude, for adult patients with fracture of distal, the long-term function between casting and plate is similar. Although the radiological parameters of closed reduction and casting are poor, it does not reduce the range of motion of the wrist joint, nor increase the rate of reoperation, which is firstly chosen for older adults. [ABSTRACT FROM AUTHOR]

BACKGROUND: New traction splint is developed base on “elastic fixation” theory of traditional splint and “minimal movement” theory of promoting fracture healing, which exhibits broad application values and prospects in the treatment of distal radius fractures. OBJECTIVE: To explore the performance of the new traction splint by clinical research, and to improve its deficiencies. METHODS: Forty patients with distal radius fractures were randomly divided into trial (new traction splint) and control (plaster fixation) groups (n=20 per group). The X-ray films of the wrist joint were performed immediately, 2 and 6 weeks postoperatively to compare the fracture healing. PACS system was used to measure the height of radius, palm inclination and ulnar deviation immediately and 6 weeks postoperatively. The pain and swelling degree at 0, 3, 7 and 14 days were compared. The wrist function was assessed according to Gartland and Werley evaluation system. RESULTS AND CONCLUSION: (1) The speed of fracture healing and swelling relief in the trial group were significantly better than those in the control group (P < 0.05). (2) The curative efficacy at postoperative 6 weeks in the trial group was significantly superior to that in the control group (P < 0.05), and the curative efficacy showed no significantly between two groups at postoperative 3 months. (3) There was no significant difference in the height of radius, palm inclination and ulnar deviation after reduction and 6 weeks after fixation between two groups (P > 0.05). The change value of palm inclination in the control group was slightly superior to that in the trial group. (4) Different degrees of complications occurred in both groups, but the incidence of severe complications in the trial group was lower than that in the control group. (5) Our findings indicate that the new traction splint has obvious advantages and definite curative effect in the treatment of distal radius fracture, but there are many shortcomings. It needs to be improved in the aspects of light weight, shape, traction structure and inner lining. [ABSTRACT FROM AUTHOR]

BACKGROUND: There are various methods for treating fractures and treatment outcomes are different. Thereafter, a review is needed to investigate the optimal implants in the treatment of distal radius fractures. OBJECTIVE: To review the different options of implants in the treatment of distal radius fractures. METHODS: A computer-based retrieval of PubMed (from January 2000 to March 2018) and CNKI (from January 1979 to December 2017) databases was conducted for the related literature. The keywords were “distal radius fracture, Colles fracture, Smith fracture, Barton Fracture and operation” in English and Chinese, respectively. Totally 70 eligible articles were included. RESULTS AND CONCLUSION: (1) Distal radius fractures are commonly seen in clinical practice. The purpose of treatment is to recover the function of the wrist joint by restoring the anatomy of the articular surface. (2) There is no method that can treat all types of distal radius fractures, and sometimes a single surgical procedure cannot completely treat complicated distal radius fractures. (3) There is no uniform treatment standard in clinical practice. By summarizing the foregoing, a unified treatment standard for the system is obtained. (4) Therefore, according to the specific fracture type, degree of displacement, age, complications, and functional requirements of the patient, an optimal and individualized plan is established for each patient. (5) For partial complicated fractures of the distal radius, combined treatment with a variety of implants will often achieve satisfactory results. [ABSTRACT FROM AUTHOR]

BACKGROUND: In view of the anatomy of the distal femur, most patients require surgical treatment, and conservative treatment is only applicable to a very small number of patients. OBJECTIVE: To explain the latest treatment options for distal femoral fractures, and to provide a basis for the selection of various repair methods by comparing the clinical and biological data published in the literature. METHODS: The first author searched the articles from the PubMed database and the Chinese National Knowledge Infrastructure published from January 1990 to December 2016. The key words were “distal femoral fracture, treatment”. A total of 75 related articles were retrieved and 51 articles met the inclusion criteria. RESULTS AND CONCLUSION: (1) Treatment options for distal femoral fractures include: external fixator, angle fixation device, steel plate, intramedullary nail, and joint replacement. (2) Fixation technology continues to develop, and there are various fixation ways for distal femoral fracture. Setting individualized treatment and choosing the right way can achieve good results. [ABSTRACT FROM AUTHOR]

BACKGROUND: It is difficult to predict the spatial displacement accurately and timely during the elongation of tibia in the osteotomy by using Ilizarov external fixation. OBJECTIVE: To load axial load, simulate the acquisition of three-dimensional (3D) models with Ilizarov external fixation by finite element analysis software (ANSYS), establish the calculation method of the axial relative displacement, and provide theoretical basis and adjustment method for clinical monitoring the quality of osteotomy length. METHODS: The 3D model was built in Mimics by using CT scan of the bone-Ilizarov external fixator (four-bar eccentric distribution) in a patient. The model was optimized in Solidworks. The tibia elongation was assumed to be 20 mm. The model was established according to the horizontal displacement of distal fragment in coronal sections (0, 4, 7, 10, 13 and 16 mm). The axial force of Ilizarov external fixator was set to 200 N and it was analyzed by finite element method through ANSYS static module. The coordinate position of net force was calculated according to the load data, and the magnitude and direction of the tibial osteotoma were calculated. RESULTS AND CONCLUSION: (1) The models of different horizontal displacement of the distal fragment in coronal section (0, 4, 7, 10, 13 and 16 mm) were loaded. The horizontal offset (0.8, 2.9, 5.4, 8.3, 11.8, 14.9 mm) and errors (0.8, 1.1, 1.6, 1.7, 1.2, 1.1 mm) were calculated respectively. (2) When the calculation error was not less than 1.7 mm, the displacement direction of the distal fragment could be determined, which provided a quantitative basis for clinical treatment; it calculated the external fixed adjustment method and corrected the deformity. (3) In conclusion, the model of Ilizarov external fixation is analyzed by using finite element method, and the mathematical model is established to calculate the axial offset of the distal fragment. When the calculation error is not less than 1.7 mm, the distal fragment displacement can be determined according to the coordinate position of net force, which can guide the regulation of Ilizarov external fixation in clinic, and avoid bone lengthening complications. [ABSTRACT FROM AUTHOR]

BACKGROUND: Operative correction of hallux valgus is one of the most procedures in foot and ankle department, but postoperative plaster slab immobilization often brings great inconvenience and pain. Off-loading forefoot shoes can theoretically help them to do activities off bed early, and prevent loading on the forefoot during walking. But its advantages and disadvantages compared with plaster slab are still unknown. OBJECTIVE: To compare the clinical effects of over-the-toe plaster slab and off-loading forefoot shoes after hallux valgus correction. METHODS: Patients with hallux valgus undergoing distal Chevron osteotomy or Scarf osteotomy in the Huashan Hospital of Fudan University between May 2012 and October 2013 were retrospectively reviewed. Group A patients had a below-knee and over-the-toe plaster slab while Group B had an off-loading forefoot shoe applied after surgery. Radiological assessment was done at 6 weeks postoperatively. Immobilization was removed once bone union was indicated. Clinical scales and subjective satisfaction investigation were performed at final follow-up, and complications during follow-up were noted. All values between groups were analyzed statistically. RESULTS AND CONCLUSION: Totally 125 patients (157 feet) were completely followed up, including 83 patients (95 feet) in Group A and 42 patients (62 feet) in Group B. There was no significant difference in demographics, pre-and-post operative radiological assessments, clinical scale, union time or general satisfaction rates between two groups. However, Group B patients had less chance to suffer metatarsophalangeal joint or inter-phalangeal joint stiffness, restricted ankle motion and supra-ankle pains of operated side in comparison with Group A (P < 0.05), and were more willing to accept the same treatment if they could choose again (P < 0.05). Compared with the plaster slab, the application of off-loading shoes not only maintains correction level, but also reduces such complications as stiffness or restricted motion of the joint, limb pains and so on, which makes patients more likely to accept, and should be given priority to in the rehabilitation following hallux valgus correction. [ABSTRACT FROM AUTHOR]

BACKGROUND: Mechanisms related to bone fracture and nonunion have been clarified, but the healing time and treatment strategy of delayed union remain controversial. OBJECTIVE: To establish a reliable model of femoral delayed union using external fixation in the New Zealand white rabbit. METHODS: Seventy-two New Zealand white rabbits were randomized to three groups. After removal of 10-mm femoral middle bone cortex with internal and external periosteum and bone marrow, a uniplanar external fixator was used. There was a 1 mm gap between broken ends (group A), and the broken ends were sealed by bone wax (group B). For controls, only bone cortex was cut and then fixed to contact the broken ends. The gross, radiological and histological observations were performed to observe the bone healing at 4, 8 and 12 weeks after modeling. RESULTS AND CONCLUSION: The control group achieved bone healing at the 4th week, which was considered as the normal time of bone healing. The groups A and B achieved healing at the 12th week, which was remarkably longer than that in the control group. The rabbit femoral delayed union model showed the typical X-ray imaging and pathological features of delayed union. Our results suggest that the model is reasonable and reliable, which can provide reference for clinical research. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the needle puncture safety and clinical efficacy of manual reduction combined with external fixation of ankle frame in the treatment of trimalleolar fracture under the guidance of Chinese Osteosynthesis (CO) theory., Methods: The clinical data of 118 patients with trimalleolar fractures admitted from December 2010 to December 2021 were retrospectively analyzed. Fifty-three patients were treated with manual reduction combined with external fixation of ankle frame(observation group). Sixty-five patients were treated with open reduction and internal fixation with plate and screws(control group). The operation time, hospitalization days, non-weight-bearing time of the affected limb, clinical healing time of fracture, incidence of complications, visual analogue scale (VAS) before and 1 month after operation, and American Orthopedic Foot and Ankle Society(AOFAS) score of ankle joint before and 1 year after operation were compared between the two groups., Results: Patients in both groups were followed up for more than 1 year. All patients were followed up, and the duration ranged from 14 to 70 months, with an average of(35.28±14.66) months. There were statistically significant in operation time, hospitalization days, non-load-bearing time of affected limbs, clinical healing time of fractures and VAS score one month after operation between the two groups. One month after operation, the VAS score of the observation group was lower than that of the control group( t =3.343, P =0.001). The operation time of the observation group was significantly shorter than that of the control group( t =9.091, P =0.000). The hospitalization days in the observation group were significantly less than those in the control group( t =5.034, P =0.000). The non-load-bearing time of the affected limb in the observation group was significantly shorter than that in the control group( t =11.960, P =0.000). The clinical healing time of fracture in the observation group was significantly shorter than that in the control group( t =4.007, P =0.000). There was no significant difference in AOFAS score between the two groups one year after operation( t =0.417, P =0.678). In the observation group, there were 2 cases of pinhole infection and 3 cases of loss of reduction less than 2 mm. There were 3 cases of surgical incision infection in the control group. There was no significant difference in the incidence of complications between the two groups( χ 2 =0.446, P =0.504)., Conclusion: Manual reduction combined with external fixation is safe and effective in the treatment of trimalleolar fracture under the guidance of CO theory, and the function of ankle joint recovers well after operation. This therapy has good clinical value.

Objective: To compare the clinical efficacy between closed reduction combined with semi-circular external fixator and minimally invasive percutaneous plate osteosynthesis (MIPPO) in the treatment of middle anddistal tibia fractures., Methods: The clinical data of sixty patients with middle and distal tibia fractures admitted between January 2019 and November 2022, were retrospectively analyzed. These patients were categorized into external fixation group ( n =30) and internal fixation group ( n =30). There were 18 males and 12 females in the external fixation group, with an average age of (49.29±2.35) years old. Among them, 14 patients presented with fractures on the left side, and 16 patients presented with fractures on the right side. Closed reduction, arched wire, and semi-circular external fixator were used for treatment. There were 20 males and 10 females in the internal fixation group, with an average age of (48.96±1.87) years old. Among them, 15 patients presented with fractures on the left side, and 15 patients presented with fractures on the right side. MIPPO technique was used for the treatment. Perioperative parameters, including time injury to surgery, surgical duration, incision length, intraoperative bleeding, time to active activity, and incision healing level, were compared between the two groups. Clinical outcomes were also assessed, including Johner-Wruhs scores, time to minimum pain-adapted full weight-bearing, visual analog scale (VAS), SF-36 scale, and complications., Results: The external fixation group exhibited a significantly shorter incision length (1.36±0.86) cm and lower intraoperative bleeding (10.83±5.73) ml compared to the internal fixation group (12.74±3.12) cm and (86.47±8.90) ml, respectively( P <0.05). The postoperative active activity time (1.50±0.54) days and minimum pain-adapted full weight-bearing activity time(108.87±3.43) days in the external fixation group were slightly delayed than the internal fixation group(1.15±0.98) days and (105.27±3.68) days, respectively( P <0.05). Over a mean postoperative follow-up duration of (6.23±1.89) months, both groups showed improved VAS and SF-36 scale scores. There were no statistically significant differences in VAS and SF-36 scale scores 1, 3, 6 months post-operatively between the two groups( P >0.05). The intraoperative surgical time in the external fixation group (35.42±9.31) minutes was shorter than that in the internal fixation group(74.22±7.81) minutes ( P <0.05). There was no intraoperative vascular or nerve injury, nor postoperative skin necrosis in the external fixation group. However, skin necrosis was observed in 6 patientsin the internal fixation group, representing a statistically significant difference ( P <0.05)., Conclusion: Both external fixation and plate internal fixation are effective methods for the treatment of middle and distal tibia fractures. External fixation exhibits the advantage of less surgical trauma and a lower incidence of complications.

Objective: To investigate the effectiveness of single Taylor external fixator combined with biplanar osteotomy on correction of tibial multiplanar deformities., Methods: Between October 2016 and December 2021, 11 patients with tibial multiplanar deformities (20 sides) were treated with single Taylor external fixator and biplanar osteotomy. Of them, 4 were male and 7 were female; the average age ranged from 13 to 33 years (mean, 21.9 years). Diagnosis included rickets severe genu varum deformity (7 cases, 14 sides), rickets severe genu valgum deformity (2 cases, 4 sides), multiple osteochondromatosis calf deformity (1 case, 1 side), neurofibromatosis medial lower leg anterior arch deformity with short of leg (1 case, 1 side). After fibular osteotomy and tibial multiplanar osteotomy, a Taylor external fixator was installed. After operation, the deformities were corrected successively and fixed completely. The osteotomy healed, then the external fixator was removed. Before operation and at 12 months after operation, the full-length X-ray films were taken. The leg-length discrepancy, medial proximal tibial angle (MPTA), lateral distal tibial angle (LDTA), posterior proximal tibial angle (PPTA), anterior distal tibial angle (ADTA), and tibial rotation angle were measured. The degree of lower limb deformity was scored with reference to a customized tibial mechanical axis scoring table., Results: Osteotomy was successfully completed without neurovascular injury and other complications. The external fixator was adjusted for 28-46 days, with an average of 37 days, and the external fixator was worn for 136-292 days, with an average of 169 days. Mild needle infection during the fixation period occurred in 3 sides, refracture at the distal tibial osteotomy in 1 side after removing the external fixator, and nonunion of the distal fibular osteotomy in 1 side. All patients were followed up 369-397 days (mean, 375 days). At 12 months after operation, the lower limb discrepancy decreased, but there was no significant difference ( P >0.05). MPTA, LDTA, PPTA, ADTA, and tibial rotation angle improved, and the differences in LDTA, ADTA, and tibial rotation angle were significant ( P <0.05). The score of lower limb deformity was significantly higher than that before operation ( P <0.05), and the results were excellent in 9 sides, good in 8 sides, fair in 3 sides, with the excellent and good rate of 85%., Conclusion: Single Taylor external fixator combined with biplanar osteotomy is effective in the correction of tibial multiplanar deformities.

Objective: To evaluate the effectiveness of limited internal fixation combined with a hinged external fixator in the treatment of peri-elbow bone infection., Methods: The clinical data of 19 patients with peri-elbow bone infection treated with limited internal fixation combined with a hinged external fixator between May 2018 and May 2021 were retrospectively analyzed. There were 15 males and 4 females with an average age of 44.6 years (range, 28-61 years). There were 13 cases of distal humerus fractures and 6 cases of proximal ulna fractures. All the 19 cases were infected after internal fixation of fracture, and 2 cases were complicated with radial nerve injury. According to Cierny-Mader anatomical classification, 11 cases were type Ⅱ, 6 cases were type Ⅲ, and 2 cases were type Ⅳ. The duration of bone infection was 1-3 years. After primary debridement, the bone defect was (3.04±0.28) cm, and the antibiotic bone cement was implanted into the defect area, and the external fixator was installed; 3 cases were repaired with latissimus dorsi myocutaneous flap, and 2 cases were repaired with lateral brachial fascial flap. Bone defects repair and reconstruction were performed after 6-8 weeks of infection control. The wound healing was observed, and white blood cell (WBC), erythrocyte sedimentation rate (ESR), and C-reaction protein (CRP) were reexamined regularly after operation to evaluate the infection control. X-ray films of the affected limb were taken regularly after operation to observe the bone healing in the defect area. At last follow-up, the flexion and extension range of motion and the total range of motion of the elbow joint were observed and recorded, and compared with those before operation, and the function of the elbow joint was evaluated by Mayo score., Results: All patients were followed up 12-34 months (mean, 26.2 months). The wounds healed in 5 cases after skin flap repair. Two cases of recurrent infection were effectively controlled by debridement again and replacement of antibiotic bone cement. The infection control rate was 89.47% (17/19) in the first stage. Two patients with radial nerve injury had poor muscle strength of the affected limb, and the muscle strength of the affected limb recovered from grade Ⅲ to about grade Ⅳ after rehabilitation exercise. During the follow-up period, there was no complication such as incision ulceration, exudation, bone nonunion, infection recurrence, or infection in the bone harvesting area. Bone healing time ranged from 16 to 37 weeks, with an average of 24.2 weeks. WBC, ESR, CRP, PCT, and elbow flexion, extension, and total range of motions significantly improved at last follow-up ( P <0.05). According to Mayo elbow scoring system, the results were excellent in 14 cases, good in 3 cases, and fair in 2 cases, and the excellent and good rate was 89.47%., Conclusion: Limited internal fixation combined with a hinged external fixator in the treatment of the peri-elbow bone infection can effectively control infection and restore the function of the elbow joint.

Objective: To explore clinical efficacy of external placement of micro-locking plate combined with small incision reduction in treating proximal phalanx comminuted fractures., Methods: From January 2018 to December 2019, 17 patients with proximal phalanx comminuted fractures were treated with micro-locking plate combined with small incision open reduction, including 13 males and 4 females, aged from 16 to 64 years old with an average of (37.2±20.1) years old. Two patients were accompanied by soft tissue extrusion and opening injuries, which were treated with fixed treatment after the first-stage emergency debridement. Curative effect was evaluated according to total active flexion scale (TAFS) of American Hand Surgery Association at 6 months after operation;and fracture healing, nailing, local soft tissue healing, complications were observed., Results: All patients were followed up from 6 to 12 months with an avaerge of(9.3±3.6) months. Two patients occurred delayed union, 1 occurred local skin necrosis and was treated with the second-stage skin grafting to repair wound surface. No external screw breakage or infection was reported, skin soft tissue healed favorably and reached bony union, the union time from 12 to 24 weeks with an average of (15.7±2.1) weeks. According to TAFS standard, 9 patients got excellent result, 5 good and 3 poor at 6 months after operation., Conclusion: External micro-locking plate combined with small incision reduction in treating proximal phalanx comminuted fracture, which has advantages of good condition of skin and soft tissue, simple operation, early functional exercise, good range of motion of interphalanx joint, and function score of recovery period is high.

Knee joint distraction is a new technology for the treatment of knee osteoarthritis in recent years. It could reduce knee pain and improve knee function, which is inseparable from the role of cartilage repair. The mechanism and influencing factors of knee joint distraction in repairing cartilage are the focus of current research. In this paper, the author reviewed literature and found that knee joint distraction could reduce knee joint load and provide a appropriate mechanical environment for cartilage repair, and it is resulting hydrostatic pressure fluctuation in the knee joint not only helps cartilage to absorb nutrients, but also promotes cartilage formation genes and inhibits cartilage matrix degrading enzyme gene expression. In addition, knee joint distraction creates conditions for synovial mesenchymal stem cells to be collected to cartilage injury, and improves ability of synovial mesenchymal stem cells to proliferate and differentiate into a chondrogenic lineage. Knee joint distraction could reduce inflammatory reaction and cartilage injury of knee joint by reducing content of inflammatory factors and inhibiting expression of inflammatory genes. At present, it is known that the factors affect repair of cartilage by knee joint distraction include, increasing weight-bearing activity and height and time of distraction is helpful for cartilage repair, male patients and patients with higher severity of knee osteoarthritis have better cartilage repair effect after knee joint distraction.The better efficacy of cartilage repair on the first year after knee joint distraction predicts a higher long-term survival rate of knee joint distraction with knee preservation. However, the research on the above hot spots is only at the initial stage and further exploration is still needed, in order to better guide clinical application of knee joint distraction.

Objective: To explore the clinical therapeutic strategies of refracture after Ilizarov bone transport technique in the treatment of tibial bone defect., Methods: A retrospective study was performed on 19 patients with infected tibial bone defect treated by Ilizarov bone transport technique and then refracture from August 2010 to January 2020, including 18 males and 1 female with an average age of (37.7±13.0) years old ranging from 15 to 66 years old. Cause of injury invlved falling injury in 4 cases, crashing injury 1 case, crushing injury in 1 case and without obvious injury history in 13 cases. The ipsilateral distal femoral fracture in 2 cases occurred before the external fixator of tibia was removed, and the other 17 cases had a minimum of 1 day and a maximum of 30 months after the external fixator had been removed. The site of refracture was at regenerative zone in 8 cases, at docking site in 9 cases, at ipsilateral femoral shaft in 2 cases. According to the modified Simpson classification proposed by the author, the refracture was classified. The treatment of refracture include plaster splint, traction or external fixation. Bone healing and function were evaluated according to the standards of the Association for the Study and Application of the Method of Ilizarov(ASAMI)., Results: All patients were followed up, and the duration ranged from 9 to 17 months with an average of (12.3±3.2) months. According to the modified Simpson classification, there were 3 cases of type Ⅰa, 1 case of type Ⅰb, 3 cases of type Ⅰc, 1 case of type Ⅱ, 9 cases of type Ⅲ and 2 cases of type Ⅴ. All the refractures healed without infection or malunion. The fracture healing time of conservative treatment for 6 cases were 3, 5, 3, 2, 2, 2 months fespectively;and the healing time of fracture treated by surgery for 13 cases was 2 to 6 months, with an average of(4.4±1.4) months. According to ASAMI evaluation criteria, bony results showed all patients obtained excellent results, and functional results showed 6 patients got excellent results, 13 good beacause of ankle or knee stiffness., Conclusion: The modified Simpson classification could contain most clinical types of refracture after bone transport, and the external fixation is a simple and effective method for refracture.

Objective: To compare treatment effect of monolateral and circular external fixator in infectious tibial nonunion and to explore external fixation structure with better osteogenic ability and fewer complications., Methods: A retrospective analysis was performed on 150 patients with infectious tibial nonunion admitted from January 2010 to December 2014. Patients who met the inclusion and exclusion criteria were divided into monolateral fixator group and circular fixator group according to the type of external fixation. Demographic and perioperative data of the two groups were collected. New bone quality was assessed by pixels ratio, treatment effect was assessed by complications. Notes for treatment was explored by case analysis., Results: A total of 64 patients with infectious mid-tibial nonunion were included, 26 in monolateral fixator group and 38 in circular fixator group. There was no difference in demographic data between two groups. The pixel ratio of new bone between two groups was from 0.91 to 0.97 with an average of (0.94±0.03), and from 0.93 to 0.97 with an average of(0.95±0.02), respectively, with no statistical significance ( P >0.05). The external fixation index was from 34.1 to 50.6 with an average of (42.3±8.3) days /cm in monolateral fixator group and from 44.5 to 56.1 with an average of (45.8±10.3) days/cm in the circular fixator group, and the difference was not statistically significant ( P >0.05). There were 7 cases (26.9%) of complications in monolateral fixator group and 5 cases (13.2%) in circular fixator group, the difference was not statistically significant ( P >0.05), but 5 cases of foot ptosis in monolateral fixator group and none in circular fixator group. The time of weight bearing in monolateral fixator group was later than that in circular fixator group, and the difference was statistically significant ( P <0.05)., Conclusion: Monolateral and circular fixators can achieve equivalent bone formation in the treatment of infected tibial nonunion. Circular fixator is recommended for patients with severe osteoporosis or concomitant medical diseases requiring early weight bearing. Hydroxyapatite coated screws are recommended if a monolateral external fixator is selected when the expected enlarged length is long and the fixation time is long and close monitoring of the ankle movement is required to avoid foot droop.

Objective: To investigate the clinical effect of NRD assisted Ilizarov technique in the treatment of infected bone and soft tissue defect of tibia., Methods: All 48 patients with infected bone and soft tissue defect of tibia were randomly divided into study group and control group from March 2013 to December 2020. There were 34 males and 14 females, aged from 24 to 55 years old with an average of (40.54±11.64) years old. There were 25 patients in the study group, including 17 males and 8 females, aged from 31 to 55 years old with an average of (41.36±9.69) years old. The study group were treated with NRD assisted with Ilizarov bone transport technique. There were 23 patients in control group, including 17 males and 6 females, aged from 24 to 53 years old with an average of(38.61±8.76) years old. The control group were treated with traditional bone transport technique. The curative rate, recurrence rate, incidence rate of pin track infection, time of using antibiotics, time of wound healing, time of carrying external fixation, time of bone transport, time of bone healing and postoperative function were used to evaluate the therapeutic effect of the two groups., Results: The follow-up period was from 12 to 62 months with an average of (33.0±7.2) months. At the final follow-up, there was no significant difference in the curative rate between the two groups ( P >0.05). The recurrence rate in the study group was lower than that in the control group( P <0.05). The incidence of pin track infection in the study group was lower than that in the control group ( P <0.05). The time of using antibiotics and wound healing in the study group was shorter than that in the control group( P <0.05). There was no significant difference in the time of bone transport and carrying of external fixation between the two groups( P >0.05). There was no significant difference in bone healing and postoperative function between the two groups( P >0.05)., Conclusion: NRD assisted Ilizarov technique can achieve satisfactory results in the treatment of infected bone and soft tissue defect of tibia and shorten the treatment period and the time of using antibiotics. It is worthy of development in clinic.

Objective: To investigate the effectiveness difference between bone transport with a locking plate (BTLP) and conventional bone transport with Ilizarov/Orthofix fixators in treatment of tibial defect., Methods: The clinical data of 60 patients with tibial fractures who met the selection criteria between January 2016 and September 2020 were retrospectively analyzed, and patients were treated with BTLP (BTLP group, n =20), Ilizarov fixator (Ilizarov group, n =23), or Orthofix fixator (Orthofix group, n =17) for bone transport. There was no significant difference in gender, age, cause of injury, time from injury to admission, length of bone defect, tibial fracture typing, and comorbidities between groups ( P >0.05). The osteotomy time, the retention time of external fixator, the external fixation index, and the occurrence of postoperative complications were recorded and compared between groups. The bone healing and functional recovery were evaluated by the Association for the Study and Application of the Method of Ilizarov (ASAMI) criteria., Results: All patients of 3 groups were followed up 13-45 months, with a mean of 20.4 months. The osteotomy time was significantly shorter in the BTLP group than in the Ilizarov group, and the retention time of external fixator and the external fixation index were significantly lower in the BTLP group than in the Ilizarov and Orthofix groups ( P <0.05). Twenty-two fractures healed in the Ilizarov group and 1 case of delayed healing; 16 fractures healed in the Orthofix group and 1 case of delayed healing; 18 fractures healed in the BTLP group and 2 cases of delayed healing. There was no significant difference between groups in fracture healing distribution ( P =0.824). After completing bone reconstruction treatment according to ASAMI criteria, the BTLP group had better bone healing than the Orthofix group and better function than the Ilizarov groups, showing significant differences ( P <0.05). Postoperative complications occurred in 4 cases (20%) in the BLTP group, 18 cases (78%) in the Ilizarov group, and 12 cases (70%) in the Orthofix group. The incidence of complication in the BTLP group was significantly lower than that in other groups ( P <0.05)., Conclusion: BTLP is safe and effective in the treatment of tibial defects. BTLP has apparent advantages over the conventional bone transport technique in osteotomy time, external fixation index, and lower limb functional recovery.

Objective: To summarize and analyze the characteristics and treatment strategies of post-traumatic lower limb deformity based on QIN Sihe Orthopaedic Surgery Database., Methods: A clinical data of 837 patients with post-traumatic lower limb deformities treated by orthopaedic surgery between May 25, 1978 and December 31, 2020 in QIN Sihe Orthopaedic Surgery Database were analyzed retrospectively. The information of the patient's gender, age at the time of surgery, region of origin, cause of trauma, deformity side, orthopedic surgery related information (operation time, location, type, and fixation method after operation) were summarized and analyzed., Results: All patients came from 32 provinces, municipalities, autonomous regions, and Taiwan in China. Among them, 551 cases (65.83%) were male and 286 cases (34.17%) were female. The age of the patients at the time of surgery was 3-84 years old, with an average of 27.6 years old, and the most patients were 16-45 years old (559 cases, 66.78%). The main cause of trauma was traffic accident injury (639 cases, 76.34%). The deformity mainly involved unilateral limbs, including 394 cases (47.07%) on the left side and 376 cases (44.92%) on the right side. The most patients were admitted between 2008 and 2017, accounting for 53.05% (444/837). All patients were operated on one or more sites (1 048 sites), among which ankle and toe surgery were the most, accounting for 48.38% (507/1 048). The patients received 1204 surgeries including tendon lengthening and soft tissue contracture release, et al . Orthopedic surgery combined with bone external fixation was used in 624 cases (467 cases of Ilizarov external fixation and 157 cases of combined external fixation), and plaster or brace external fixation was used in 213 cases., Conclusion: Post-traumatic lower extremity deformity patients have a large proportion of males, with a wide geographical distribution, involving various parts of the lower extremities, and most commonly in the foot and ankle. Orthopedic surgery combined with bone external fixation (Ilizarov technique) is the main methods for correction and functional reconstruction of post-traumatic lower limb deformity.

Objective: To investigate the clinical effect of applying the digital six-axis external fixation frame based on CT data in the treatment of tibiofibular fractures. Methods: The clinical data of 43 patients with tibiofibular fractures treated by the self-developed digital six-axis external fixation frame based on CT data at Integrated Orthopedic Department of Traditional Chinese Medicine (TCM) and Western Medicine,HongHui Hospital from January 2018 to January 2021 were retrospective analysis.There were 27 males and 16 females,aged (36.0±9.4) years(range:25 to 50 years).AO classification:15 cases of 42A,11 cases of 42B, and 17 cases of 42C.There were 7 open fractures and Gustilo fracture classification:2 cases of type Ⅰ,4 cases of type Ⅱ,and 1 case of type Ⅲ.The two or three plane rings were connected with six connecting rods to form a complete six-axis external fixation frame,and the distal and proximal fracture blocks were connected to the distal and proximal rings by fixation pins,and the lengths of the six connecting rods needed to be adjusted were calculated by using the supporting software according to the CT data after surgery,and then the lengths of the connecting rods were adjusted one by one to complete the reduction of the fracture. The reduction accuracy of this six-axis external fixation brace was evaluated by measuring postoperative radiographs; postoperative recovery and complications were collected,the time of brace removal was recorded,and the function of the affected limb was evaluated according to the Johner-Wruhs score at the final follow-up. Results: Postoperative radiographs showed that all patients achieved satisfactory reduction with lateral displacement( M (IQR)) of 2.3(2.5) mm (range:0.3 to 7.3 mm),anteroposterior displacement of 2.1 (2.4) mm (range:0.3 to 5.7 mm),anteroposterior angulation of 2.5(2.4)°(range:0 to 5°),internal and external angulation of 2.1(1.5)°(range:0 to 4°), and no significant internal or external rotational deformity was detected on the exterior.On the second postoperative day,all patients were able to walk with partial weight-bearing on crutches. All 43 patients were followed up for more than 6 months,with a follow-up period of (33.3±7.3) weeks (range:24 to 42 weeks).The external fixation frame was removed after the fracture healed.The external frame was removed at 20(3)weeks (range:18 to 25 weeks) postoperatively. Up to the final follow up, no secondary fracture occurred in any of them.The Johner-Wruhs score of the affected limb at the last follow-up was excellent in 39 cases and good in 4 cases. Conclusion: The digital six-axis external fixator based on CT data for tibiofibular fractures has the advantages of precise reduction,firm fixation,simple operation,rapid fracture healing,and minimal trauma, which is a minimally invasive method for treating tibiofibular fractures,especially suitable for patients with poor skin and soft tissue conditions such as open injuries.

The software of 3D-Modeling(UG NX 10.0) was used to design a new external fixator model for proximal femoral fracture, and fresh femoral cadaver specimens were used to simulate experimental operation. The results showed that the external fixator designed with the proximal femoral locking plate shape can improve the accuracy of Kirschner wire penetration into the femoral neck, reduce fluoroscopic and soft tissue incision injuries, and make a good stability and is easy to operate, which has a certain value for patients with proximal femoral fracture, such as intolerant surgery and poor physical condition.

Objective: To explore the clinical efficacy of external micro-locking plate combined with closed reduction in the treatment of fifth metatarsal comminuted fracture with severe soft tissue injury., Methods: From January 2018 to December 2019, 13 patients received micro-locking plate combined with closed reduction treatment due to the fifth metatarsal comminuted fracture with severe soft tissue injury. There were 11 males and 2 females patients, ranging in age from 21 to 69 years. According to the fracture AO fracture classification, 9 cases belonged to type 87(S)-C2.2 and 4 cases belonged to type 87(S)-C2.1. The fifth metatarsal cuneiform articular surface was not involved, and all of them were comminuted fractures of the fifth metatarsal shaft. All soft tissues were damaged to varying degrees. Three patients got small defect of skin and soft tissue, and they were treated with debridement and suture after one-stage emergency surgery. The fracture healing and complications were observed, and the clinical efficacy was evaluated according to the midfoot function score of American Orthopaedic Foot & Ankle Society (AOFAS) at the latest follow-up., Results: All patients were followed up, and the duration ranged from 3 to 12 months. One patient had delayed union. One patient had local skin necrosis and was treated with second-stage skin grafting to repair the wound surface. No external screw breakage or infection was reported, the skin soft tissue healed satisfactorily and reached bony union, with the union time ranging from 8 to 19 weeks. The postoperative functional recovery was rated according to the midfoot score of AOFAS, the score ranged from 49 to 98, and 7 patients got an excellent result, 4 good, 1 fair and 1 poor., Conclusion: The external micro-locking plate combined with closed reduction in the treatment of fifth metatarsal comminuted fracture with severe soft tissue injury has the advantages of simple operation, good stability and low infection rate, which is helpful to the repair of soft issue injury, and the fixation can be removed early in outpatient clinic. To sum up, this surgical procedure is suitable for patients with severe soft tissue injury and comminuted fracture to avoid periosteum stripping. The space occupying is smaller than the micro-external fixator, which is convenient for patients with early functional exercise.

Objective: To study the clinical efficacy and complications of Endobutton titanium plate and clavicle hook plate in the treatment of acromioclavicular dislocation., Methods: Total 48 patients with Rockwood Ⅲ to Ⅴ acromioclavicular joint dislocation from March 2015 to May 2019 were retrospectively divided into two groups according to different surgical methods. Among the patients, 23 patients were treated with Endobutton loop titanium plate fixation (observation group), including 15 males and 8 females, ranging in age from 23 to 59 years old, with an average of(36.2±8.1) years old;Rockwood type Ⅲ in 6 cases, type Ⅳ in 11 cases and type Ⅴ in 6 cases. Twenty-five patients were treated with clavicular hook plate(control group), including 17 males and 8 females, ranging in age from 22 to 54 years old, with an average of (34.7±6.4) years old; Rockwood type Ⅲ in 6 cases, type Ⅳ in 14 cases and type Ⅴ in 5 cases. The operation time, intraoperative bleeding, hospitalization time, visual analogue scale (VAS) of pain, Constant-Murley score of shoulder function and postoperative complications were compared between the two groups., Results: All the patients were followed up, and the duration ranged from 24 to 51 months, with a mean of (30.5±6.5) months. The amountof bleeding and hospitalization time in the observation group were (71.9±4.0) ml and(8.2±1.6) d respectively;and those in the control group were (97.6±13.4) ml and (12.8±1.2) d respectively. There was significant difference between the two groups ( P <0.05). There was no significant difference in operation time between the two groups( P >0.05). The VAS scores of the observation group immediately after operation and 12 months after operation were 4.00±0.39 and 1.58±0.13 respectively, which were statistically significant compared with 7.32±0.43 and 3.09±0.23 in the control group ( P <0.05). The Constant-Murley scores of shoulder function in the observation group were 59.65±0.15 and 85.97 ±0.73 immediately and 12 months after operation, which were significantly different from those in the control group 52.77±0.19 and 55.78±0.19( P <0.05). In the observation group, there were 1 case of shoulder pain and 1 case of ectopic ossification; in the control group, there were 1 case of internal fixation failure, 3 cases of acromion impact, 3 cases of shoulder pain and 3 cases of ectopic ossification. There was significant difference between the two groups ( P <0.05)., Conclusion: Compared with clavicular hook plate internal fixation in the treatment of acromioclavicular joint dislocation, Endobutton loop titanium plate internal fixation technology has the advantages of less surgical bleeding, shorter hospitalization time, less postoperative pain, good recovery of shoulder joint function and less complications.

Objective: To study the clinical effect of individualized controllable stress external fixator in the treatment of open tibial fractures., Methods: From December 2018 to July 2020, 60 patients with open tibial fractures were treated, including 35 males and 25 females;The age ranged from 23 to 58 years;The course of disease was 1.2 to 10.0 h. According to the stress stimulation on the fracture end after operation, all patients were divided into 4 groups, including non stress group (15 cases) and 3 groups with different stress stimulation(15 cases in each group). All patients with open tibial fractures were treated with controllable stress external fixator. Four weeks after operation, the stress group adjusted the elastic external fixator to apply axial stress of 1/6, 2/6 and 3/6 of their own weight to the fracture end based on the patient's weight. The wound healing of all patients after operation was observed, the plain CT images of fracture ends at 4, 6, 8, 10 and 12 weeks after operation were followed up, the average valueof callus area per 10 scanning planes was calculated, and the differences between the groups were compared. The fracture healing was observed and statistically analyzed., Results: The wounds of all patients healed well, of which 7 patients underwent secondary free skin grafting and transferred myocutaneous flap. All patients were followed up for 12 to 24 months, with an average of 16.5 months. The final follow-up results showed that the fracture healing of stress groups and non stress group had significant difference( P <0.05). After axial stress stimulation at the fracture end, CT examination was performed on the fracture end of all patients at 4, 6, 8, 10 and 12 weeks. The average values of callus area in 10 plain scanning planes were calculated as follows:no stress group (0.275±0.092) mm 2 , (0.383±0.051) mm 2 , (0.412±0.048) mm 2 , (0.472± 0.019) mm 2 , (0.548±0.036) mm 2 , the area of callus growth in the stress group was significantly higher than that in the non stress group. There was significant difference among these groups( P <0.05)., Conclusion: When the controllable stress external fixation technique is used to treat open tibial fractures, the elastic external fixator is adjusted according to the patient's own weight after 4 weeks, and a certain axial stress is applied to the fracture end, which is conducive to the fracture healing of patients, and can reduce the incidence of delayed union or nonunion of open fractures, which has a certain application value.

Objective: To explore clinical efficicacy of closed manipulative reduction and external fixation with cardboard splint in treating Monteggia fracture., Methods: Fifty-eight children with Monteggia fracture were underwent closed manipulative reduction and external fixation with cardboard splint from January 2010 to Junuary 2018. Among them, including 37 males and 21 females, aged from 3.5 to 12 years old with an average of (8.48±2.29) years old;the courses of disease ranged from 0.5 hours to 9 days with an average of (4.21±1.46) days. Broberg and Morrey scores before treatment, 1, 3 and 6 months after treatment were used to evaluate clinical effects., Results: All children were followed up from 1 to 6 months with an average of (3.35±2.12) months. Broberg and Morrey score (7.24±2.81) before treatment, (32.06 ±8.33) at 1 month after treatment, (73.18±5.56) at 3 months after treatment and (95.87±6.75) at 6 months after treatment; there were statistical differences at each time points after treatment with before treatment ( P <0.05);37 children got excellent results, 19 good and 1 moderate., Conclusion: Treatment of Monteggia fractures with closed manipulative reduction and external fixation with cardboard splint could reach integration of motion and quietness, also could remove external fixation at early stage, and get obvious short-term and medium-term therapeutic results.

Objective: To explore the clinical effect of manual reduction combined with homemade splint external fixation in the treatment of metacarpal fractures., Methods: A retrospective analysis was performed in 126 patients with metacarpal fracture treated by manual reduction and homemade splint external fixation in the emergency department of our hospital from January 2018 to December 2018, including 102 male, 24 female, ranging in age from 9 to 73 year old, with an average of (33.2±14.3)years old. During the treatment, the X-ray was re-examined regularly, and the external fixation was continued or adjusted according to the X-ray situation. The X-ray showed callus growth. After the fracture was stable, the external fixation was removed to continue functional exercise. The TAM scoring standardwas used to evaluate the hand function, and the fracture healing and complications were summarized., Results: Of the 126 patients, 6 patients were treated with operation because of fracture displacement during the treatment. The other 120 patients were treated with this method and all of them got bony healing. The healing time was (6.3±1.8) weeks. The follow up time ranged from 2 to 12 months, with a mean of (4.4±2.2) months. At the latest follow up, TAM score was used to evaluate the hand function:excellent in 105 cases, good in 13 cases, fair in 2 cases and poor in 0 case. Shortening deformity was found in 7 cases and angulation deformity in 3 cases., Conclusion: Manual reduction combined with homemade splint external fixation in the treatment of metacarpal fractures can achieve good clinical results. Homemade splint is easy to obtain materials and low cost, and it is an effective method worthy of clinical promotion.

Objective: To compare clinical efficacy and safety of plate internal fixation (ORIF) and external fixator (EF) in treating distal radius fractures by Meta-analysis., Methods: From establishment of database to August, 2019, randomized controlled trial (RCT) about open reduction and internal fixation (ORIF) and external fixation (EF) in treating distal radius fractures was conducted by using computer-based databases, including CNKI, VIP, Wanfang Data, Medline, Cochrane library databases. Data extraction and quality evaluation of included study according to inclusion and exclusion criteria, RevMan 5.3 software was used to perform Meta-analysis. Palm angle, ulnar deflection angle, radius height, grip strength, ulnar variation, disabilities of arm, shoulder and hand (DASH) score, total complication rate, infection rate and tendon rupture between two groups were compared., Results: Totally 19 RCT were included with 1 730 patients, 873 patients in ORIF group and 857 patients in EF group. Meta analysis result showed that after operation at 12 months, there were no significant difference in radial height [ MD =0.04, 95%CI (-0.90, 0.99), P =0.93], tendon rupture [ RR =1.82, 95% CI (0.71, 4.67), P =0.21], carpal tunnel syndrome [ RR =2.15, 95% CI (0.98, 4.70), P =0.06], complex regional pain syndrom [ RR =0.63, 95% CI (0.31, 1.27) P =0.78] between two groups. While there were significant difference in palm inclination angle [ MD =1.38, 95% CI (0.83, 1.93), P < 0.000 01], ulnar deflection angle[ MD =0.99, 95% CI (0.54, 1.45), P <0.000 1], ulna variability[ MD =0.66, 95% CI (0.21, 1.12), P =0.005], DASH score[ MD =2.42, 95% CI (0.37, 4.46), P =0.02], incidence of complications[ RR =0.83, 95% CI (0.71, 0.96), P =0.01], infection rate[ RR =0.20, 95% CI (0.11, 0.36), P <0.000 1]between two groups. There was statistical difference in tendinitis incidence between two groups [ MD =3.88, 95% CI (1.56, 9.64), P <0.003]., Conclusion: Compared with EF in treating distal radius fracture, ORIF has better clinical effects in postoperative complications, palm angle, ulnar deviation angle, ulnar variation rate and infection rate. While there were no significant difference between in DASH score, radial height, tendon rupture and carpal tunnel syndrome better EF and ORIF. For the patient pursue rapid recovery of function, ORIF is better choice.

Objective: To explore clinical effect of locking plate external fixation combined with membrane induction technology in treating open and comminuted tibial fractures with bone defects., Methods: Totally 92 patients of open and comminuted tibial fractures with bone defects were chosen form January 2018 to July 2019, and randomly divided into external fixation group and internal fixation group, 46 patients in each group. In external fixation group, there were 29 males and 17 females, aged from 25 to 62 years old, with an average of (37.45±10.92) years old;according to AO classification, 15 patients were type A, 22 patients were type B and 9 patients were type C;according to Gustilo classification, 21 patients were typeⅡ, 10 patients were type ⅢA, 10 patients were type ⅢB, 5 patients were type Ⅲ C;treated by fracture reduction with locking plate external fixation. In internal fixation group, there were 31 males and 15 females, aged from 23 to 60 years old, with an average of(36.88±10.64) years old;according to AO classification, 18 patients were type A, 20 patients were type B and 8 patients were type C; according to Gustilo classification, 22 patients were typeⅡ, 11 patients were type ⅢA, 7 patients were type ⅢB, 6 patients were type Ⅲ C;treated by traditional open reduction with plate internal fixation. Operation time, intraoperative blood loss, incision length, hospital stay, fracture healing time and lower limb full weight-bearing time and postoperative complications between two groups were observed and compared, bone mineral density, osteocalcin, blood calcium and phosphorus before operation and 1 month after operation., Results: All patients were followed up from 12 to 18 months with an average of (14.92±2.46) months. Operation time, intraoperative blood loss, incision length, hospital stay, fracture healing time and lower limb full weight-bearing time of external fixation group were significantly better than that of internal fixation group( P <0.05). Postoperative bone mineral density, osteocalcin, blood calcium and phosphorus at 1 month in external group were higher than that of internal fixation group ( P <0.05). Four patients in external fixation group occurred complications, 13 patients in internal fixtaion group, and occurrence rate of complications in external fixation group (8.70%) was lower than that of internal fixtaion group (28.26%)( χ 2 =4.618, P =0.032)., Conclusion: Locking plate external fixation combined with membrane induction technology in treating open and comminuted tibial fractures with severe post-traumatic bone defects has advantages of less trauma, reliable fixation, shorter fracture healing time, and could improve bone metabolic activity with less postoperative complications.

Objective: To retrospectively analyze the clinical efficacy of external fixation in the treatment of femoral neck fracture with two different pin layout., Methods: From April 2000 to April 2018, 140 cases of femoral neck fracture were treated with closed reduction and percutaneous pin external fixation, among them 121 cases were followed up for more than 1 year, including 31 cases in traditional group, 12 males and 19 females, aged 45 to 74(65.4±8.4) years;90 cases in modified group, 39 males and 51 females, aged 12 to 75 (64.5±7.8) years. In traditional group, the first needle was put on the femoral talus, the second and third needles were put under the tension line, and the three needles were not on the same line in the lateral phase; in modified group, the first needle was drilled into the lateralcortex of the femur, obliquely penetrating the distal and proximal end of the femoral talus fracture, and the other two needles were drilled into the medial cortex of the femoral neck and the femoral talus, respectively. The operation time, hospital stay, postoperative ambulation time, femoral neck shortening rate, fracture healing time, fracture healing rate and femoral head necrosis rate of the two groups were observed and compared. Harris hip function score was used one year after operation., Results: These 121 patients were followed-up, the follow up time of traditional group was 13 to 45(30.5±11.4) months;the follow-up time of modified group was 14 to 120(34.5±12.5) months. There was no significant difference in operation time, hospital stay and femoral head necrosis rate between two groups ( P >0.05). There were significant differences between two groups in the time of going to the ground, shortening rate of femoral neck, fracture healing time, fracture healing rate and Harris functional score of the hip 1 year after operation ( P <0.05)., Conclusion: Compared with the traditional group, the modified group has the advantages of lower femoral neck shortening rate, shorter fracture healing time, higher fracture healing rate and higher Harris hip function score.